The association of arsenic metabolism with cancer, cardiovascular disease, and diabetes

A systematic review of the epidemiological evidence

Chin Chi Kuo, Katherine A. Moon, Shu Li Wang, Ellen Silbergeld, Ana Navas Acien

Research output: Contribution to journalReview article

Abstract

Background: The available evidence on the role of arsenic metabolism in individual susceptibility to the development of cancer, cardiovascular disease, and diabetes has not been formally and comprehensively reviewed. OBJECTIVES: Our goal was to systematically investigate the association of arsenic metabolism with cancer, cardiovascular disease, and diabetes- related outcomes in epidemiologic studies. As a secondary objective, we characterized the variation of arsenic metabolism in different populations worldwide. Methods: We searched Medline/PubMed and EMBASE from inception to January 2016 and applied predetermined exclusion criteria. Compositional data analysis was used to describe the distribution of arsenic metabolism biomarkers and evaluate the association between arsenic exposure and metabolism. Results: Twenty-eight studies met the inclusion criteria, 12 on cancer, nine on cardiovascular disease, and seven on diabetes-related outcomes. The median (interquartile range) for mean iAs%, MMA%, and DMA% was 11.2 (7.8-14.9)%, 13.0 (10.4-13.6)%, and 74.9 (69.8-80.0)%, respectively. Findings across studies suggested that higher arsenic exposure levels were associated with higher iAs% and lower DMA% and not associated with MMA%. For cancer, most studies found a pattern of higher MMA% and lower DMA% associated with higher risk of all-site, urothelial, lung, and skin cancers. For cardiovascular disease, higher MMA% was generally associated with higher risk of carotid atherosclerosis and clinical cardiovascular disease but not with hypertension. For diabetes-related outcomes, the pattern of lower MMA% and higher DMA% was associated with higher risk of metabolic syndrome and diabetes. Conclusions: Population level of iAs% and DMA%, but not MMA%, were associated with arsenic exposure levels. Overall, study findings suggest that higher MMA% was associated with an increased risk of cancer and cardiovascular disease, while lower MMA% was associated with an increased risk of diabetes and metabolic syndrome. Additional population-based studies and experimental studies are needed to further evaluate and understand the role of arsenic exposure in arsenic metabolism and the role of arsenic metabolism in disease development.

Original languageEnglish (US)
JournalEnvironmental Health Perspectives
Volume125
Issue number8
DOIs
StatePublished - Aug 1 2017

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Arsenic
Cardiovascular Diseases
Neoplasms
Population
Carotid Artery Diseases
Skin Neoplasms
PubMed
Epidemiologic Studies
Lung Neoplasms
Biomarkers
Hypertension

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

Cite this

The association of arsenic metabolism with cancer, cardiovascular disease, and diabetes : A systematic review of the epidemiological evidence. / Kuo, Chin Chi; Moon, Katherine A.; Wang, Shu Li; Silbergeld, Ellen; Navas Acien, Ana.

In: Environmental Health Perspectives, Vol. 125, No. 8, 01.08.2017.

Research output: Contribution to journalReview article

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abstract = "Background: The available evidence on the role of arsenic metabolism in individual susceptibility to the development of cancer, cardiovascular disease, and diabetes has not been formally and comprehensively reviewed. OBJECTIVES: Our goal was to systematically investigate the association of arsenic metabolism with cancer, cardiovascular disease, and diabetes- related outcomes in epidemiologic studies. As a secondary objective, we characterized the variation of arsenic metabolism in different populations worldwide. Methods: We searched Medline/PubMed and EMBASE from inception to January 2016 and applied predetermined exclusion criteria. Compositional data analysis was used to describe the distribution of arsenic metabolism biomarkers and evaluate the association between arsenic exposure and metabolism. Results: Twenty-eight studies met the inclusion criteria, 12 on cancer, nine on cardiovascular disease, and seven on diabetes-related outcomes. The median (interquartile range) for mean iAs{\%}, MMA{\%}, and DMA{\%} was 11.2 (7.8-14.9){\%}, 13.0 (10.4-13.6){\%}, and 74.9 (69.8-80.0){\%}, respectively. Findings across studies suggested that higher arsenic exposure levels were associated with higher iAs{\%} and lower DMA{\%} and not associated with MMA{\%}. For cancer, most studies found a pattern of higher MMA{\%} and lower DMA{\%} associated with higher risk of all-site, urothelial, lung, and skin cancers. For cardiovascular disease, higher MMA{\%} was generally associated with higher risk of carotid atherosclerosis and clinical cardiovascular disease but not with hypertension. For diabetes-related outcomes, the pattern of lower MMA{\%} and higher DMA{\%} was associated with higher risk of metabolic syndrome and diabetes. Conclusions: Population level of iAs{\%} and DMA{\%}, but not MMA{\%}, were associated with arsenic exposure levels. Overall, study findings suggest that higher MMA{\%} was associated with an increased risk of cancer and cardiovascular disease, while lower MMA{\%} was associated with an increased risk of diabetes and metabolic syndrome. Additional population-based studies and experimental studies are needed to further evaluate and understand the role of arsenic exposure in arsenic metabolism and the role of arsenic metabolism in disease development.",
author = "Kuo, {Chin Chi} and Moon, {Katherine A.} and Wang, {Shu Li} and Ellen Silbergeld and {Navas Acien}, Ana",
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T1 - The association of arsenic metabolism with cancer, cardiovascular disease, and diabetes

T2 - A systematic review of the epidemiological evidence

AU - Kuo, Chin Chi

AU - Moon, Katherine A.

AU - Wang, Shu Li

AU - Silbergeld, Ellen

AU - Navas Acien, Ana

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: The available evidence on the role of arsenic metabolism in individual susceptibility to the development of cancer, cardiovascular disease, and diabetes has not been formally and comprehensively reviewed. OBJECTIVES: Our goal was to systematically investigate the association of arsenic metabolism with cancer, cardiovascular disease, and diabetes- related outcomes in epidemiologic studies. As a secondary objective, we characterized the variation of arsenic metabolism in different populations worldwide. Methods: We searched Medline/PubMed and EMBASE from inception to January 2016 and applied predetermined exclusion criteria. Compositional data analysis was used to describe the distribution of arsenic metabolism biomarkers and evaluate the association between arsenic exposure and metabolism. Results: Twenty-eight studies met the inclusion criteria, 12 on cancer, nine on cardiovascular disease, and seven on diabetes-related outcomes. The median (interquartile range) for mean iAs%, MMA%, and DMA% was 11.2 (7.8-14.9)%, 13.0 (10.4-13.6)%, and 74.9 (69.8-80.0)%, respectively. Findings across studies suggested that higher arsenic exposure levels were associated with higher iAs% and lower DMA% and not associated with MMA%. For cancer, most studies found a pattern of higher MMA% and lower DMA% associated with higher risk of all-site, urothelial, lung, and skin cancers. For cardiovascular disease, higher MMA% was generally associated with higher risk of carotid atherosclerosis and clinical cardiovascular disease but not with hypertension. For diabetes-related outcomes, the pattern of lower MMA% and higher DMA% was associated with higher risk of metabolic syndrome and diabetes. Conclusions: Population level of iAs% and DMA%, but not MMA%, were associated with arsenic exposure levels. Overall, study findings suggest that higher MMA% was associated with an increased risk of cancer and cardiovascular disease, while lower MMA% was associated with an increased risk of diabetes and metabolic syndrome. Additional population-based studies and experimental studies are needed to further evaluate and understand the role of arsenic exposure in arsenic metabolism and the role of arsenic metabolism in disease development.

AB - Background: The available evidence on the role of arsenic metabolism in individual susceptibility to the development of cancer, cardiovascular disease, and diabetes has not been formally and comprehensively reviewed. OBJECTIVES: Our goal was to systematically investigate the association of arsenic metabolism with cancer, cardiovascular disease, and diabetes- related outcomes in epidemiologic studies. As a secondary objective, we characterized the variation of arsenic metabolism in different populations worldwide. Methods: We searched Medline/PubMed and EMBASE from inception to January 2016 and applied predetermined exclusion criteria. Compositional data analysis was used to describe the distribution of arsenic metabolism biomarkers and evaluate the association between arsenic exposure and metabolism. Results: Twenty-eight studies met the inclusion criteria, 12 on cancer, nine on cardiovascular disease, and seven on diabetes-related outcomes. The median (interquartile range) for mean iAs%, MMA%, and DMA% was 11.2 (7.8-14.9)%, 13.0 (10.4-13.6)%, and 74.9 (69.8-80.0)%, respectively. Findings across studies suggested that higher arsenic exposure levels were associated with higher iAs% and lower DMA% and not associated with MMA%. For cancer, most studies found a pattern of higher MMA% and lower DMA% associated with higher risk of all-site, urothelial, lung, and skin cancers. For cardiovascular disease, higher MMA% was generally associated with higher risk of carotid atherosclerosis and clinical cardiovascular disease but not with hypertension. For diabetes-related outcomes, the pattern of lower MMA% and higher DMA% was associated with higher risk of metabolic syndrome and diabetes. Conclusions: Population level of iAs% and DMA%, but not MMA%, were associated with arsenic exposure levels. Overall, study findings suggest that higher MMA% was associated with an increased risk of cancer and cardiovascular disease, while lower MMA% was associated with an increased risk of diabetes and metabolic syndrome. Additional population-based studies and experimental studies are needed to further evaluate and understand the role of arsenic exposure in arsenic metabolism and the role of arsenic metabolism in disease development.

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JO - Environmental Health Perspectives

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